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A  Discourse 
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DISCOURSE 


PUBLIC  DUTIES  OF  MEDICAL  MEN, 


DELIVERED    AS   AN 


INTRODUCTORY  LECTURE 


COLLEGE  OF  PHYSICIANS  AND  SURGEONS 


IN  THE  CITY  OF  NEW-YORK, 


November  2d,  1846. 


BY  JOSEPH  MATHER  SMITH,  M.  D. 

Professor  of  the  Theory  and  Practice  of  Physic,   and  Clinical  Medicine. 


N  E  W-Y  0  R  K  : 

DANIEL     A  D  E  E,      PRINTER,      107      FULTON-STREET. 

1846. 


PUBLISHED    BY    BEQUEST 

OF    THE    STUDENTS    OF    THE    COLLEGE 

OF    PHYSICIANS    AND    SUBGEONS    OF    THE    UNIVEBSITY 

OF    THE     STATE    OF    NeW-YoEK. 

SESSION  OF  1846—7. 


DISCOURSE. 


Gentlemen : 

The  study  of  medicine,  next  to  that  of  Divinity,  if 
rightly  directed  and  applied  to  its  appropriate  objects,  is, 
of  all  intellectual  pursuits,  the  most  widely  contributive  to 
human  happiness.  It  embraces  in  its  scope  not  only  the 
structure,  and  laws  which  govern  the  economy  of  organized 
beings,  and  particularly  that  of  man,  but  also  the  history 
and  properties  of  the  agents  which  are  operative  in  pro- 
ducing disease,  and  in  restoring  and  preserving  health. 
Comprehending,  in  a  word,  the  phenomena  of  life,  and 
whatever  tends  to  affect  the  mind  and  body,  the  science  of 
medicine  may  be  said  to  extend  over  a  wider  field  of  in- 
quiry than  any  other  department  of  human  knowledge. 

With  this  view  of  medical  science,  the  elements  of  which 
form  the  subjects  of  the  several  courses  of  lectures  deliver- 
ed in  this  branch  of  our  State  University,  allow  me  to  lead 
your  minds  to  the  contemplation  of  some  of  the  duties 
which  will  necessarily  devolve  upon  those  who  make  the 
practice  of  Physic  the  pursuit  of  their  lives.  In  doing 
this,  I  am  influenced  by  the  conviction  that  nothing  can 
afford  to  the  ingenuous  student  a  stronger  incentive  to  in- 
dustry,  than  a  plain  exhibition  of  the  high  responsibilities 
the  physician  assumes,  in  entering  on  the  practice  of  his 
profession. 


The  duties  of  the  physician  may  be  properly  divided  in- 
to public  and  private.  The  latter,  which  relate  to  the  im- 
mediate attendance  on  the  sick,  and  the  alleviation  and  re- 
moval of  individual  suffering,  have  so  frequently  been  the 
theme  of  discourse  in  books  and  popular  lectures,  that  I 
shall  not  defain  you  by  attempting  to  repeat  them.  The 
former  are,  for  the  most  part,  of  a  different  kind : — they 
concern  the  general  health  and  happiness  of  the  community 
at  large ;  and  it  is  in  the  performance  of  them,  that  the 
character,  talents,  and  acquirements  of  the  physician,  are, 
in  a  degree,  exposed  to  the  observation  and  scrutiny  of  the 
world.  The  nature  of  these  public  duties,  and  the  qualifi- 
cations necessary  to  discharge  them  satisfactorily,  will  af- 
ford, it  is  believed,  a  subject  sufficiently  interesting  to  en- 
gage your  attention  on  the  present  occasion. 

No  physician  can  be  qualified  to  perform  the  various  du- 
ties imposed  on  him  by  the  public  authorities,  without  an 
extensive  and  particular  knowledge  of  the  several  depart- 
ments of  medical  science ;  for  it  is  the  possession  of  such 
knowledge  only,  that  can  secure  to  him  the  confidence  of 
the  public,  and  sustain  the  true  dignity  of  the  profession. 

Of  the  many  subjects,  an  acquaintance  with  which  is  in- 
dispensable in  him,  who  undertakes  to  aid  in  the  delibera- 
tions of  legislative  bodies,  respect  ng  the  public  health,  there 
are  none  more  important  than  the  causes  of  disease,  and  the 
means  of  obviating  and  counteracting  their  effects.  To 
enable  one  to  speak  with  decision  and  authority  on  such 
subjects,  it  is  necessary  to  be  conversant  with  the  varieties 
of  climate  and  soil,  the  situation  and  topography  of  coun- 
tries, the  occupations,  diet,  and  habits  and  manners  of  the 
people.  The  influence  of  these  severally,  are  every  where 
known  to  be  powerfully  operative  on  the  human  constitu- 
tion ;  and  their  united  agency  is  deemed,  by  every  sound 


philosopher,  to  have  been  sufficiently  energetic  to  produce 
all  the  varieties  of  color,  and  configuration  of  body,  which 
are  observed  among  the  different  races  of  men. 

The  immediate  and  diversified  effects  of  climate  are  in- 
teresting to  every  class  of  persons ;  but  to  none  is  the  study 
of  its  multifarious  relations  so  important  as  to  the  student 
of  medical  science.  Its  direct  influence  in  producing  and 
modifying  diseases,  and,  its  subsidiary  effect,  in  giving  energy 
to  causes  which  otherwise  would  be  inactive,  should  be  sub- 
jects of  special  inquiry  with  every  one  who  wishes  to  attain 
that  knowledge,  which  will  qualify  him  to  discharge  his 
public  duties,  and  elevate  him  in  the  scale  of  professional 
reputation.  The  glory  of  Hippocrates  was  derived  not 
more  from  his  sagacity  as  a  pathological  observer,  than 
from  his  knowledge  of  the  character  of  diseases,  as  affected 
by  the  influences  of  air,  water,  and  localities. 

But  let  us  take  a  more  particular  view  of  the  services 
which  the  physician  may  be  called  to  render  to  the  commu- 
nity. 

Among  the  subjects  on  which  his  opinion  may  be  requir- 
ed, are  the  qualities  of  the  waters  used  in  diet  and  for  other 
purposes ;  the  properties  and  effects  of  certain  articles  of 
food  ;  and  the  best  mode  of  preserving  the  health  and  lives 
of  persons  employed  in  certain  manufacturing  and  other 
occupations.  His  opinion  may  also  be  demanded  with  re- 
gard to  the  location,  plan,  economical  arrangement,  and 
dietaries  of  hospitals,  alms-houses,  prisons,  and  seminaries 
of  learning.  To  be  enabled  to  advise  on  these  various  sub- 
jects, it  is  necessary  to  have  a  knowledge  of  the  principles 
of  hygiene,  and  to  be  informed  with  regard  to  the  effects  of 
the  various  systems  of  management  pursued  in  the  manu- 
facturing, humane,  criminal,  and  literary  institutions  of 
different  countries. 


6 


But  it  is  in  relation  to  matters  connected  with  the  ori- 
gin, diffusion,  and  prophylactics  of  pestilential  diseases, 
that  the  physician  is  required  to  discharge  duties  of  a 
higher  and  more  responsibta  character. 

Few  cities  in  maritime  situations,  and,  indeed,  few  of  any 
magnitude  in  the  interior  of  countries,  are  exempt  from 
the  occasional  ravages  of  pestilential  epidemics.  The 
frightful  aspect  of  these  diseases,  and  the  fury  with  which 
they  frequently  commence  and  pursue  their  career  of  deso- 
lation, have,  from  the  earliest  ages,  given  them  the  first  rank 
in  the  list  of  human  calamities. 

In  such  seasons,  when  the  popular  mind  is  alarmed  and 
turned  from  its  ordinary  occupations,  the  responsibilities  of 
the  physician  occasion  anxieties  of  extreme  intensity ;  for, 
on  him  then  devolves,  not  merely  the  duty  of  announcing 
the  appearance  of  the  disease,  but  of  watching  and  report- 
ing its  progressive  extension,  and  of  studying  its  origin, 
nature,  peculiarities  and  treatment. 

To  enable  you  to  form  a  just  idea  of  the  circumstances, 
in  which  he  is  required  to  perform  such  important  services, 
it  will  not  be  improper  to  cite  a  few  examples  of  the  terri- 
ble fatality  of  pestilential  epidemics,  and  of  the  depressing- 
moral  effects  they  produce  on  the  community  in  which  they 
prevail.  During  the  plague  of  London,  in  1665,  the  deaths 
were  numbered  at  upwards  of  6S,000.  In  1709,  the  same 
disease  prevailed  in  Dantzic,  and  destroyed  about  25,000 
of  its  inhabitants.  In  the  following  year  30.000  perished 
by  it,  in  the  city  of  Stockholm.  In  1719,  it  ravaged  Aleppo, 
destroying  in  a  short  period  30,000  persons.  Numerous  in- 
stances of  epidemic  plague,  equally  devastating,  might  be 
adduced  ;  but  it  is  deemed  sufficient  to  add  one  or  two  ex- 
amples illustrative  of  the  mortality  of  yellow  fever,  or  that 
form  of  pestilence  which  has  so  frequently,  within  the  last 


hundred  years,  visited  the  principal  Atlantic  cities  of  the 
United  States,  and  some  of  the  larger  sea-port  towns  of 
southern  Europe.  Sir  Gilbert  Blane  well  remarks  that, 
"in  respect  to  mortality,  this  epidemic  takes  precedence 
even  of  the  plague ;  for,  in  a  population  of  16.000,  civil 
and  military  in  Gibraltar  in  1804,  there  perished  6,000  ;  a 
proportion  considerably  above  that  of  the  pestilence  of  the 
Levant.  In  our  own  country,  this  disease  has  been  scarcely 
less  malignant  and  fatal.  Nearly  4,000  died  of  it  in  Phila- 
delphia in  1793 ;  and  its  prevalence  in  this  city,  and  in 
other  American  cities  in  1795,  and  in  subsequent  years,  af- 
fords similar  evidence  of  its  extraordinary  rate  of  mor- 
tality. 

As  the  plague  and  certain  other  malignant  distempers,  of 
former  ages,  have  left  enduring  memorials  of  their  destruc- 
tive energy,  so  will  the  epidemic  cholera  leave  indelible  traces 
of  its  ravages  in  the  present  century.  Commencing  its  de- 
vastations in  1817,  in  the  Delta  of  the  Ganges,  this  fell 
disease  has  over-run  many  of  the  most  populous  cities  and 
regions  of  the  old  and  new  world,  destroying  millions  of 
our  race. 

To  complete  the  view  of  the  terrific  character  of  ma- 
lignant epidemic  visitations,  let  us  contemplate  their  influ- 
ence on  the  moral  feelings.  There  are  perhaps  no  circum- 
stances which  more  powerfully  affect  the  popular  mind  than 
those  of  pestilence.  The  intellectual  energies  are  paraly- 
zed ;  the  depressing  passions  are  awakened :  and  the  com- 
mon vocations  of  men  are  abandoned,  or  pursued  with  di- 
minished alacrity.  The  history  of  epidemics  furnishes  many 
illustrations  of  these  remarks.  Thucydides,  in  his  admi- 
rable account  of  the  pestilence  which  ravaged  Athens,  du- 
ring the  invasion  of  Attica  by  the  Peloponnesians  and  their 
allies,  says,  to  use  the  words  of  his  translator  Dr.  Cliftonr 


8 

"  that  the  most  terrible  circumstance  of  all  was  the  depres- 
sion of  mind  in  those,  that  found  themselves  beginning  to 
be  ill ;  for,  growing  immediately  desperate,  they  gave  them- 
selves over,  without  making  any  resistance."  After  describ- 
ing the  horrible  mortality  in  the  city  generally,  he  remarks, 
that  "  the  temples,  where  they  dwelt  in  tents,  were  also  full 
of  the  dead  that  died  there ;  for,  oppressed  to  the  last  ex- 
tremity by  the  violence  of  the  distemper,  and  not  knowing 
what  course  to  take,  men  grew  equally  careless  about  holy 
and  profane  things.  So  deeply  impressed  were  the  Atheni- 
ans with  the  idea  that  certain  destruction  awaited  them, 
that  they  yielded  themselves  up  to  desperation,  and  finally 
to  every  licentious  excess."  "  As  to  laborious  works'"  says, 
Thucydides,  "no  man  was  forward  to  undertake  anything 
noble  or  laudable,  not  knowing  whether  they  should  live  to 
finish  it ;  but,  what  any  man  knew  to  be  delightful  and 
every  way  conducing  to  pleasure,  that  was  made  both  hono- 
rable and  profitable ;  neither  the  fear  of  the  gods,  nor  the 
laws  of  men  restrained  any.  For,  with  respect  to  the  one, 
they  concluded  from  what  they  saw,  that  it  was  all  the  same, 
whether  they  worshipped,  or  not  worshipped,  all  men  dying 
without  distinction ;  and  with  respect  to  the  other,  no  man 
expected  that  his  life  would  last  till  the  law  could  punish 
him  for  his  misdemeanor." 

To  a  similar  state  of  grief  and  despair  were  the  people 
of  London  reduced  by  the  plague,  to  which  I  have  alluded. 
Dr.  Hodges  tells  us  that  the  consternation  was  inexpressi- 
ble, "  The  whole  British  nation  wept  for  the  miseries  of 
her  metropolis."  After  narrating  in  detail  the  desolating 
progress  of  the  disease,  he  emphatically  exclaims, 

Quis  talia  fando 


Temperet  a  lachrymis  ? 

The  gloom  and  despondency  which  take  possession  of  the 


mind  in  seasons  of  pestilence,  give  a  new  aspect  to  every- 
thing connected  with  the  present  and  future.  Dr.  Rush, 
in  his  narrative  of  the  state  of  his  mind  during  the  yel- 
low fever  in  1793,  says,  "  My  perception  of  time  was  new 
to  me.  It  was  uncommonly  slow.  The  ordinary  business 
and  pursuits  of  men  appeared  to  me  in  a  light  that  was 
equally  new.  The  hearse  and  the  grave  mingled  them- 
selves with  every  view  I  took  of  human  affairs." 

Such  is  a  feeble  description  of  the  calamities  of  pesti- 
lence, the  moral  and  physical  phenomena  of  which  are  ex- 
tremely interesting  to  every  reflecting  mind. 

Now,  it  is  in  the  midst  of  such  scenes,  that  the  physician 
is  expected  to  act  with  intelligence  and  deliberation.  Though 
breathing,  in  common  with  his  fellow-citizens,  a  pestilential 
atmosphere,  and  especially  so  in  his  visits  to  the  crowded 
hovels  of  poverty  and  tilth,  no  fears  or  anxieties  should  be 
allowed  to  disturb  his  equanimity  or  embarrass  his  judg- 
ment. His  is  then  emphatically  the  post  of  danger,  as  it 
is  of  duty  and  of  honor.  The  public  have  a  right  to  claim 
his  services ;  and  hence  it  is  important  that  he  be  qualified 
to  render  them  Avith  advantage  to  the  community,  and  with 
credit  to  himself  and  his  profession.  Thucydides,  in  his 
history  of  the  Athenian  pestilence,  called  upon  every  phy- 
sician to  declare  the  origin  of  the  distemper.  During  the 
plague  of  London  in  1665,  the  king  "commanded  the  Col- 
lege of  Physicians  jointly  to  write  somewhat  in  English" 
says  Dr.  Hodges,  "  that  might  be  a  general  directory  in  this 
calamitous  exigence." 

But  in  no  pestilential  period  has  recourse  to  our  profes- 
sion been  more  universal  than  during  the  wide-spread  deso- 
lations of  the  epidemic  cholera.  Wherever,  in  Europe,  the 
disease  appeared,  or  threatened  invasion,  the  municipal 
authorities    consulted    learned     physicians    and    medical 


10 

associations ;  and,  for  the  most  part,  adopted  the  methods 
suggested  by  them  for  averting  or  arresting  its  prevalence. 
On  its  appearance  in  this  city,  in  1832,  a  medical  council 
was  organized,  at  the  head  of  which  was  placed  the  emi- 
nent physician  and  surgeon,  who  now  presides  over  this  col- 
lege ;  and  whose  learning  and  practical  wisdom  are  directed 
to  the  promotion  of  its  highest  interests* 

But  how,  it  may  be  inquired,  is  the  student  to  qualify 
himself  to  serve  the  public  under  such  trying  circumstances  ? 
To  this,  it  may  be  answered,  that  it  is  by  investigating  the 
history  and  phenomena  of  epidemics.  It  is  true,  the  essen- 
tial nature  of  the  causes  of  pestilence  is  involved  in  mys- 
tery ;  and  the  laws  which  govern  the  operation  of  those 
causes  are  not  fully  ascertained.  Still,  the  circumstances 
in  which  many  of  them  originate,  and  the  mode  in  which 
their  agency  is  extended  epidemically,  are  sufficiently  well 
understood  to  enable  us  to  form  correct  opinions  with  re- 
spect to  their  general  attributes. 

It  is  well  known  that  few  medical  subjects  have  been 
more  fertile  of  controversy  than  the  origin  and  mode  of 
propagation  of  pestilential  fevers.  The  grand  question  re- 
specting the  contagiousness  or  non-contagiousness  of  these 
fevers,  though  settled  for  the  most  part,  on  this  side  of  the 
Atlantic,  is  still  agitated  among  the  physicians  of  Europe. 
As  every  measure  designed  to  prevent  or  diminish  the  evils 
of  epidemics  is  based  on  the  opinions  formed  concerning 
the  nature  of  their  causes,  and  their  mode  of  extension,  it 
may  readily  be  conceived  how  important  it  is  to  under- 
stand the  merits  of  that  controversy,  in  order  to  arrive  at 
satisfactory  conclusions.  Error  on  this  subject  is  to  be 
deprecated   not  merely  on  account  of  its  retarding  the 

*  Alexander  H.Stevens,  M.D. 


11 


progress  of  science,  but  for  a  more  important  reason.  It 
leads  to  the  adoption  of  a  system  of  measures  which  may 
be  oppressive  and  inefficient  in  its  operations. 

If  the  spread  of  pestilential  fevers  depend  upon  a  conta- 
gion transmitted  from  one  individual  to  another,  and  capa- 
ble of  being  transported  from  place  to  place,  it  is  obvious 
that  the  means  of  checking  their  diffusion  should  be  found- 
ed upon  principles  corresponding  with  the  laws,  which  are 
known  to  govern  the  extension  of  disorders  confessedly 
contagious.  But  if  they  originate  from  a  poison,  generated 
from  materials  existing  within  the  precincts  of  cities,  and 
totally  disconnected  from  the  living  human  body,  a  poison 
incommunicable  from  one  person  to  another,  but  diffused 
through  the  common  atmosphere  and  endangering  all  who 
breathe  it,  it  is  equally  plain  that  a  very  different  system 
of  means  is  required  to  stay  their  prevalence  and  prevent 
their  recurrence. 

The  theory  of  the  contagious  nature  of  plague  and  yel- 
low fever  is  so  widely  different  from  the  doctrine  of  the 
local  and  miasmatic  origin  of  those  diseases,  that  no  regu- 
lations, deduced  exclusively  from  the  one  theory,  can  be 
adapted  to  that  of  the  other  ;  nor  can  there  be  any  consis- 
tency in  a  system  of  medical  police  which  is  designed  to 
meet  both  views  of  the  subject. 

When  the  Venetian  Government  in  1423,  appointed  offi- 
cers to  guard  against  the  introduction  of  the  plague,  an 
appointment  from  which  originated  lazarettoes  and  quaran- 
tines, there  was  but  one  opinion  respecting  the  cause  of  the 
disease;  and  consequently  no  other  preventive  measures 
were  thought  of,  but  those  intended  to  exclude  its  reputed 
contagion.  From  that  period  to  the  present  day,  the  same 
principles  of  medical  police  have,  for  the  most  part,  pre- 
vailed in  regard  to  that  disease  in  the  different  countries  of 


12 

Europe ;  and  have  been  implicitly  adopted  in  this  country^ 
in  relation  to  tne  yellow  fever.  The  correctness  of  those' 
principles  were  long  since  called  in  question  by  many  re- 
spectable medical  observers ;  but  the  fears  and  prejudices 
of  mankind  have  hitherto  allowed  no  facts,  however  well 
established,  and  no  arguments,  however  conclusive,  to  in- 
duce them  so  to  alter  the  regulations  of  quarantine,  as  to 
make  them  harmonize  with  the  doctrine  of  the  endemic  or' 
miasmatic  origin  of  malignant  fevers. 

There  is  a  sentiment  in  the  human  mind,  that  strongly 
resists  innovations  in  institutions  which  have  long  been 
established ;  and  its  influence  is  seen  to  operate  with  most 
energy  in  cases  in  which  the  proposed  innovations  are 
founded  on  principles  diametrically  opposed  to  opinions, 
which  have  received  the  approbation  of  ages.  Even  the 
simplest  improvements  which  science  offers  to  the  arts,  are, 
for  the  same  reason,  often  tardily  adopted.  Since  the  re- 
vival of  letters,  great  and  important  improvements  have 
been  made  in  the  science  of  medicine ;  improvements, 
which  have  not  required  the  sanction  of  the  municipal  au- 
thorities, or  alteration  of  legislative  enactments  to  enable 
the  public  to  enjoy  the  benefits  resulting  from  them.  Had 
such  sanctions  and  emendations  of  law  been  necessary,  be- 
fore the  world  could  have  experienced  the  advantage  of 
those  improvements,  it  is  doubtful  if  medicine  would  yet 
have  emerged  from  the  darkness  of  the  fourteenth  century. 
Now,  in  common  with  every  other  department  of  medical 
science,  the  etiology  of  pestilential  fevers  has,  since  the  in- 
stitution of  quarantine,  received  large  accessions  of  truth  j 
but  it  unfortunately  happens  that  they  are,  in  a  great  mea- 
sure, practically  useless,  in  consequence  of  the  public  au- 
thorities refusing  to  adopt  the  system  of  police  and  hygiene, 
which  they  naturally  suggest. 


13 


The  only  apology  which  can  be  offered  in  justification  of 
legislative  bodies  declining  to  alter  the  laws  relating  to 
pestilential  diseases,  and  particularly  to  quarantine,  so  as 
to  make  them  consistent  with  our  improved  knowledge  of 
the  causes  of  those  diseases,  is  the  want  of  unanimity 
among  medical  men.  If  appeals,  however,  were  made  to 
those  only,  whose  learning  and  opportunities  for  observation 
have  enabled  them  to  trace  the  causes  of  malignant  fevers 
to  their  true  sources,  it  is  believed,  there  would  not  be  found 
sufficient  discrepancy  of  opinion  among  them,  to  occasion 
any  embarrassment  in  arriving  at  just  and  satisfactory  con- 
clusions on  the  subject. 

From  these  observations,  an  opinion  may  be  formed  of  the 
nature  of  the  subjects,  an  acquaintance  with  which  is  neces- 
sary, before  the  physician  can  be  qualified  to  discharge  the 
implied  obligation  he  takes  upon  himself  to  serve  the  pub- 
lic, by  pointing  out  the  means  of  removing  or  preventing 
the  calamities  of  malignant  epidemics.  In  investigating 
these  subjects  no  pre-conceived  opinions  or  idolatrous  at- 
tachment to  medical  authorities  should  be  allowed  to  in- 
fluence his  inquiries.  A  rigid  adherence  to  facts,  and  a 
strict  observance  of  the  rules  of  induction,  cannot  fail  to 
lead  him  to  correct  conclusions.  When  truth  has  been  thus 
attained,  it  is  his  imperative  duty  to  urge  it  upon  the  atten- 
tion of  legislators,  in  order  that  the  health  laws  may  be 
founded  upon  correct  principles.  Were  the  regulations  of 
quarantine  so  founded,  the  vexatious  inconveniences,  to 
which  the  crews  and  passengers  in  ships  recently  arrived, 
are,  in  many  instances,  subjected  in  this  country  and  in 
Europe,  to  say  nothing  of  the  detention  of  ships  and  their 
cargoes,  in  certain  cases,  would  not  be  experienced.  The 
interests  of  voyagers  and  the  concerns  of  commerce,  every 


14 


where,  with  perhaps  a  few  exceptions,  demand  a  reform  of 
the  systems  of  quarantine* 

But  further ;  as  it  is  the  province  of  the  physician  to  en- 
lighten the  public  on  the  subject  of  the  sources  of  pestilen- 
tial diseases ;  so  it  is,  also,  his  duty  to  indicate  other  general 
causes  of  disease,  and  to  urge  the  adoption  of  means  for 
their  correction.  Among  the  causes  referred  to,  there  is 
none  more  injurious  to  health  than  the  use  of  intoxicating 
liquors.  Indeed,  the  amount  of  disease,  poverty,  immorality 
and  crime,  produced  by  intemperance,  vastly  exceeds  that 
resulting  from  all  other  sources  of  physical  suffering,  de- 
pravity and  guilt.  It  was  remarked,  nearly  two  centuries 
ago,  by  Lord  Chief  Justice  Hale,  that  if  the  great  enormi- 
ties, which  had  come  under  his  judication  in  the  course  of 
twenty  years,  "were  divided  into  five  parts,  four  of  them 

*  The  great  movement  recently  made  in  Europe,  with  a  view  to  amend 
the  existing  quarantine  laws,  there  is  reason  to  hope,  will  result  in  the 
adoption  of  such  modifications  of  them,  as  will  make  them  accord  with 
the  present  state  of  our  knowledge  respecting  the  etiology  of  the  plague. 
"  In  1838,  a  proposal  was  made  by  the  French  to  the  British  Government 
to  promote  the  formation  of  a  congress  of  delegates  from  the  various 
European  States  having  ports  in  the  Mediterranean,  for  the  purpose  of 
agreeing  upon  some  uniform  system  of  quarantine  regulations,  to  be 
adopted  by  and  binding  upon  all."  For  much  new  and  valuable  infor- 
mation on  this  subject,  reference  may  be  had  to  "  the  Correspondence 
respecting  the  Quarantine  Laws,  &c,  presented  to  Parliament,  1846  ;" 
and  especially  to  ihs  "  Rapport  a  l'Academie  Royale  de  Medecine  sur 
la  Peste,  et  les  Quarantaines,  fait,  au  nom  d'une  commission,  par  M.  le  Dr. 
Prus,  &c,  1846,"  Analyses  of  these  documents  are  given  in  the  Med. 
Chrurg.  Review,  No.  106.  Recently,  also,  the  quarantine  laws  in  this 
country  have  attracted  attention.  Able  discussions  of  the  subject  are 
published  in  the  "  Report  of  the  special  committee  of  the  House  of  As- 
sembly of  the  State  of  New-York,  on  the  present  Quarantine  Laws, 
1846 ;"  and  in  the  twentieth  number  of  the  New-York  Journal  of  Medicine 
and  the  Collateral  Sciences,  edited  by  Charles  A.  Lee,  M.D. 


15 


would  be  found  to  be  issues  and  products  of  excessive  drink- 
ing, or  of  tavern  and  ale-house  meetings." 

Recognizing  it  as  an  obligation  incumbent  upon  him,  as  a 
physician  and  guardian  of  the  public  health,  Dr.  Rush, 
years  ago,  widely  proclaimed  the  mischiefs  and  extent  of 
this  prevailing  vice  of  our  nation.  But  it  is  only  of  late 
that  the  philanthropic  of  our  whole  country  have  been 
awakened  to  a  sense  of  its  destructive  consequences.  It  has 
been  remarked  by  a  medical  professor  in  a  neighboring  State 
University,  in  speaking  of  the  numerous  victims  of  intem- 
perance, that  "  well  may  war,  pestilence  and  famine  drop 
for  an  instant  their  weapons  of  destruction,  and  look  on 
with  astonishment  and  envious  admiration,  to  behold  their 
own  havoc  so  far  outdone." 

The  magnitude  of  the  evil  in  question,  demands  that 
every  medical  man  should  gird  himself  to  the  work  of  pro- 
moting the  temperance  reform  which  is  now  going  onward 
in  the  world ;  and  which  the  late  lamented  President  of  this 
College,  Dr.  Watts,  pronounced  the  greatest  moral  enter- 
prise of  the  age. 

But  the  public  duties  of  physicians  are  not  limited  to  the 
objects,  which  have  been  mentioned.  His  services  are  re- 
quired in  the  armies  and  navy  of  his  country.  In  these, 
he  takes  an  honorable  rank,  corresponding  with  the  responsi- 
bilities which  devolve  upon  him. 

Without  health,  no  soldiery  can  be  eifective :  and  hence 
its  preservation  is  of  the  first  importance  to  the  state.  The 
strength  of  armies  is  often  prostrated  by  disease  ;  and  to  this 
cause  is  not  unfrequently  attributed  the  miscarriage  of  mili- 
tary enterprises.  It  is  well  ascertained  that  more  troops 
perish  by  disease  than  fall  by  the  sword  ;  a  fact  deeply  in- 
teresting to  every  nation  engaged  in  war. 

The  diseases,  from  which  soldiers  most  frequently  suffer, 


16 

in  summer  and  autumn,  are  fever  and  dysentery.  Numer- 
ous examples  illustrative  of  the  great  extent  to  which  these 
maladies  prevail  in  armies,  are  recorded  in  the  memoirs  of 
military  medicine.  We  are  told  by  Sir  James  McGrigor, 
that  in  the  peninsular  army,  there  were  admitted  into  the 
British  Hospitals,  "  during  the  years  1812-13,  and  part  of 
1814,  68,894  cases  of  fever,  of  which  6,703  died,  equal  to 
9.7  per  cent.;  and  during  the  same  period  there  were  admit- 
ted into  the  regimental  hospitals  7,526  cases  of  dysentery, 
of  which  4,717  died,  or  62.5  per  cent."  It  is  said  that  we 
ought  not,  during  a  campaign,  to  calculate  upon  less  than 
ten  sick,  to  every  one  hundred  fighting  men.  According  to 
M.  Vaidy's  estimate  "  an  army  of  one  hundred  thousand 
men  may  expect  to  have  ten  thousand  sick  during  a  cam- 
paign, independent  of  any  rencontre  with  the  enemy ;  of 
which  number  five  or  six  thousand  may  be  medical  and  the 
rest  surgical  cases ;  but  after  a  battle  the  proportion  will 
be  reversed,  and  under  the  most  favorable  circumstances,  he 
calculates  upon  ten  thousand  or  twelve  thousand  wounded 
in  addition  to  the  above.'1  The  number  of  sick  and  wounded 
among  the  American  troops  in  the  present  Mexican  cam- 
paign, there  is  reason  to  believe,  will  be  found  to  confirm 
the  correctness  of  the  general  statistical  calculations  of 
Vaidy.  Exposed  as  soldiers  are  to  the  vicissitudes  of  the 
weather,  and  to  the  influence  of  climates,  rendered  un- 
healthy by  the  extremes  of  atmospheric  intemperature,  and 
noxious  exhalations  from  the  earth,  their  lives  are  constantly 
endangered,  and  their  constitutions,  however  robust,  often 
deeply  impaired  by  privations,  fatigues  and  irregularity  of 
habits. 

It  is  to  be  noticed,  however,  that  the  health  of  an  army 
is  often  remarkably  influenced  by  the  morale  of  the  troops, 
a  series  of  disasters  depressing  the  mind,  and  thus  favoring 


17 


the  action  of  morbific  agents ;  and,  on  the  other  hand,  a 
succession  of  victories  producing  mental  phenomena  which 
fortify  the  system  against  the  assaults  of  disease.  The 
latter  fact  is  strikingly  illustrated  in  the  circumstance  that 
"after  the  battle  of  Austerlitz  the  French  army,  can- 
toned in  Bavaria,  had  only  100  sick  in  a  division  of  8,000 
men." 

To  those  intrusted  with  the  health  of  soldiers,  a  know- 
ledge of  military  hygeine  and  medical  topography,  in  all 
their  details,  is  indispensable.  The  circumstances  of  armies, 
in  active  service,  are  ever  varying ;  and  consequently  every- 
thing relating  to  the  peculiar  endemic  influences  of  different 
localities,  and  to  the  qualities  of  the  articles  used  in  diet, 
should  be  well  understood  by  the  medical  officers.  The 
discipline  and  means  of  preserving  the  health  of  men  in 
the  field  are  usually  different  from  those  which  are  proper 
when  they  are  in  garrison.  In  the  former  situation,  they 
are  subjected  to  the  action  of  causes,  which  often  vary  in 
their  nature  or  mode  of  action,  with  every  change  in  the 
position  of  an  army.  In  the  latter,  the  causes  of  disease 
are  more  uniform ;  and  when  ascertained,  admit  of  the  ap- 
plication of  a  uniform  system  of  measures  for  their  correc- 
tion. In  every  situation  the  medical  officers,  if  properly 
qualified  for  their  stations,  may  render  important  services 
to  their  companions  in  arms. 

The  preservation  of  the  lives  and  health  of  soldiers  has 
been  esteemed  an  object  of  so  much  consequence  as  to 
induce  some  governments  to  institute  seminaries  for  educa- 
ting army  surgeons.  As  examples  of  this  kind,  may  be  men- 
tioned those  founded  many  years  since  at  Vienna  and  Paus. 
The  former  was  called  the  Josephine  Academy ;  and  was 
"  under  the  direction  of  the  minister  of  war,  out  of  whose 
treasury,  the  salaries  of    the   professors,   and  all   other 


18 

expenses  were  defrayed."  The  latter  was  established  in  1794, 
the  French  Republic  finding  it  necessary  to  have  medical 
officers,  specially  prepared  to  serve  in  the  navy  and  military 
hospitals*  The  advantages  of  such  institutions,  and  of 
professorships  for  teaching  military  hygeine  and  medicine 
in  general  medical  schools,  in  countries  where  there  are 
large  standing  armies,  and  particularly  in  times  of  war., 
cannot  be  doubted.  If  governments  require  the  services  of 
medical  men  in  their  military  establishments,  it  is  proper 
they  should  provide  the  means  for  educating  them. 

The  value  of  the  services  of  army  physicians  and 
surgeons  has  been  highly  estimated  from  the  earliest  ages 
of  classic  antiquity.  Homer,  in  his  Iliad,  mentions  in  the 
strongest  terms  of  commendation  the  medical  aid  afforded 
to  the  Greeks,  by  Podalirius  and  Machaon,  at  the  siege  of 
Troy.  When  the  latter  had  been  wounded  by  Paris,  he 
represents  Greece  as  trembling  for  her  physician.  In  his 
disabled  state,  at  the  command  of  Idomeneus,  he  is  trans- 
ported with  dispatch  to  the  fleet. 

"  Ascend,  thy  chariot,  haste  with  speed  away, 
And  great  Machaon  to  the  ships  convey, 
A  wise  physician  skilled  our  wounds  to  heal, 
Is  more  than  armies  to  the  public  weal." 

The  distinctions  conferred  on  military  surgeons,  in  mo- 
dern times,  attest  the  value  assigned  to  their  knowledge 
and  skill.  Napoleon,  besides  rewarding  in  a  substantial 
manner  the  services  of  Baron  Larrey,  his  Surgeon  in  Chief, 
honored  him  in  his  last  will  and  testament  with  a  bequest, 
and  pronounced  him  the  most  virtuous  man  he  had  known. 
The  laurels  acquired  by  the  surgeons  of  our  revolutionary 
army,  still  remain  in  freshness  on  their  tombs.     The  name 

*  North  American  Med.  and  Surg.  Journal,  No.  4,  p.  351,  354. 


-of  Dr.  Craik  is  rendered  imperishable  by  the  honor  bestow- 
ed upon  him,  and  by  the  legacy  left  him  by  the  illustrious 
Commander-in-Chief.  In  the  words  of  his  biographer  "  he 
was  one,  and  what  a  proud  eulogy  it  is,  of  whom  the  im- 
mortal Washington  was  pleased  to  write  in  his  will,  'my 
compatriot  in  arms,  my  old  and  intimate  friend.; " 

But  there  is  another  duty  imposed  on  the  physician,  by 
the  public  authorities.  He  is  frequently  summoned  to  give 
his  opinion  at  coroners'  inquests,  and  in  courts  of  justice. 
In  certain  criminal  cases,  subjects  exclusively  medical,  re- 
quire to  be  elucidated,  before  a  satisfactory  verdict  can  be 
rendered ;  subjects  which  sometimes  involve  questions  of  the 
most  intricate  and  perplexing  nature,  and  upon  the  correct 
decision  of  which,  depends  the  administration  of  justice. 
In  no  public  situation  can  a  physician  be  placed,  in  which 
his  medical  knowledge  is  so  likely  to  be  thoroughly  tested 
as  in  giving  testimony  before  an  enlightened  court  and 
jury  ;  and  hence,  none  but  those  who  have  devoted  them- 
selves to  the  study  of  juridical  medicine  can  appear  with 
credit  at  a  public  tribunal  as  a  medical  witness.  Whether 
the  subjects,  on  which  his  opinion  is  demanded,  relate  to 
the  slighter  offences  against  the  State,  or  to  the  more  ag- 
gravated ones  of  murder  by  mechanical  violence  or  poison ; 
or  whether  they  respect  the  condition  of  individuals  with 
regard  to  sanity  of  intellect,  the  duty  of  the  medical  jurist 
is  in  a  high  degree  responsible.  Erroneous  opinions  given 
in  such  cases,  may  sometimes  either  allow  the  guilty  to  es- 
cape retribution,  or  consign  to  death  or  imprisonment  per- 
sons innocent  of  the  charges  alleged  against  them.  Can 
any  reflection  occasion  deeper  contrition  than  that  which 
must  arise  in  the  mind  of  a  conscientious  physician  who 
discovers,  after  an  innocent  fellow-beino-  has  been  ig-nomini- 
ously  deprived  of  life,  that  through  his  ignorance,  culpable 


20 


ignorance,  he  had  contributed  to  a  result  so  fearful !  The 
great  improvements  which  have  been  made  in  Medical 
Jurisprudence  within  the  last  thirty  years,  have  given  to 
this  branch  of  medicine  so  high  a  degree  of  importance, 
that  no  medical  man  is  excusable  for  neglecting  its  study 
In  no  country  has  it  received  more  extensive  contributions 
than  in  the  United  States ;  and  I  take  pleasure  in  stating, 
that  two  of  the  graduates  of  this  college  have  given  to  the 
world  the  most  elaborate  and  valuable  elementary  work 
which  has  appeared  on  the  subject.* 

In  taking  a  general  survey  of  the  public  duties  of  phy- 
sicians, it  may  not  be  improper  to  speak  of  those  of  medi- 
cal teachers.  In  truth,  when  regarded  with  attention,  these 
duties  appear  to  be  deserving  of  more  consideration  than 
those  of  medical  men  in  any  other  situation ;  for  upon  the 
proper  performance  of  them,  in  a  great  degree  depends  the 
qualifications  of  those,  who  are  destined  to  pursue  the  prac- 
tice of  medicine  as  a  profession,  and  consequently  upon 
whom  will  devolve  the  duty  of  serving  the  community  both 
in  a  public  and  private  capacity. 

In  every  country  where  literature  and  science  receive  the 
fostering  care  of  the  government,  legislators  have  seen  the 
wisdom  of  establishing  seminaries  for  educating  youth  in 
the  elements  of  medicine  ;  and,  as  the  interests  of  the  pub- 
lic are  closely  connected  with  the  prosperity  of  such  insti- 
tutions, they  have  generally  received  the  approbation  and 
support  of  the  people.  When  regularly  organized,  and 
provided  with  the  means  of  carrying  into  effect,  a  system  of 
medical  education,  the  public  may  reasonably  expect  that 
their  welfare  will  be  promoted  by  sustaining  them,  especially 
if  the  persons  who  assume  the  responsibilities  of  instructors 

*  T.  Romeyn  Beck,  M.D.,  and  John  B.  Beck,  M.D. 


21 


be  qualified  for  their  stations.  It  is  obvious,  that  no  one 
is  fitted  for  a  preceptor,  who  is  not  himself  a  proficient  in 
the  art  or  science  he  professes  to  teach.  An  acquaintance 
with  the  elements  and  doctrines  of  the  several  branches  of 
medicine,  a  talent  for  accurate  observation  and  analytical 
research,  a  discriminating  mind,  a  facility  in  communica- 
ting knowledge,  and  studious  habits,  are  among  the  more 
important  and  essential  qualifications  of  the  medical 
teacher.  To  these,  should  be  united  a  deep  sense  of  the  re- 
sponsibility of  his  office  and  an  exemplary  moral  deport- 
ment. 

Teachers  of  theoretical  and  practical  medicine  are  per- 
haps more  prone  to  adhere  pertinaciously  to  opinions  they 
have  long  entertained,  than  professors  in  any  other  depart- 
ment of  philosophy.  They  are  too  frequently  disposed  to 
rest  their  hopes  of  fame  upon  the  establishment  of  theories 
which  new  and  accumulating  facts  are  daily  proving  to  be 
visionary.  This  disposition  to  adhere  to  doctrines,  which 
have  been  often  revolved  in  the  mind,  is,  by  no  means,  un- 
natural. It  is  frequently  the  attendant  of  old  age,  and  of 
ardent  and  opinionated  temperaments.  Sometimes  it  re- 
sults from  a  perverse  unwillingness  to  yield,  when  refuted 
by  the  plainest  and  most  conclusive  arguments.  Such  a 
disposition,  from  whatever  cause  it  may  spring,  should  be 
avoided  or  controlled  by  every  votary  of  science.  The 
teacher  of  medicine  should  carefully  avoid  its  influence ; 
for,  medicine,  perhaps  above  every  other,  is  a  progressive 
science.  Its  thories  are  often  nothing  but  ingenious  hypo- 
theses, which  serve  no  other  purpose  than  to  bind  together 
a  series  of  facts,  and  which  by  the  observation  or  discovery 
of  new  facts  are  rendered  nugatory.  Theories,  however, 
are  sometimes  usefully  employed  in  scientific  researches ; 
but  they  should  never  be  allowed  to  impede  our  progress  in 


22 


the  pursuit  of  inductive  truth.  The  late  Dr.  Win.  Hunter 
remarks,  in  his  introductory  lecture  to  anatomy,  that  "  In 
our  branch,  those  teachers  who  study  to  captivate  young 
minds  with  ingenious  speculations,  will  not  leave  a  reputa- 
tion behind  them,  that  will  outlive  them  half  a  century. 
When  they  cease  from  their  labors,  their  labors  will  be 
buried  along  with  them." 

Boerhaave,  after  completing  his  mechanical  and  humoral 
theory,  in  forming  which  he  freely  availed  himself  of  the 
labors  of  his  predecessors,  admitted  no  material  changes  in 
it.  He  devoted  his  attention  chiefly  to  the  physical  quali- 
ties of  the  body,  neglecting,  for  the  most  part,  the  pheno- 
mena, which  depend  upon  the  vital  properties.  Had  he  al- 
lowed himself  to  investigate  dispassionately,  the  opinions 
of  his  contemporaries,  Stahl  and  Hoffmann,  the  first  of 
whom  led  the  way  in  the  study  of  the  vital  powers,  and 
the  second  to  the  functions  of  the  nervous  system,  he  might 
have  so  modified  his  system  of  pathology  as  to  give  it  a 
degree  of  perfection,  that  would  perhaps  have  secured  for  it 
a  longer  duration  of  authority  in  the  schools,  and  left  less 
room  for  succeeding  pathologists  to  distinguish  themselves 
by  overthrowing  his  doctrines,  and  establishing  others  in 
their  place.  In  this  respect  Boerhaave  affords  a  striking 
instance  of  an  ingenuous  and  noble  mind,  adhering  to  a 
favorite  system,  even  when  the  light  of  truth  had  shone 
with  sufficient  brightness  to  show  its  defects* 

*  It  is  due,  however,  to  the  fame  of  this  illustrious  physician,  to  state, 
as  it  is  remarked  by  Dr.  Good,  that  "  his  mind  in  the  latter  part  of  his 
life,  was  so  fallyopen  to  the  merits  of  this  (Hoffmannian)  hypothesis,  that 
he  admitted  the  agency  of  ,the  nervous  power,  though  a  doctrine  that 
struck  at  the  i-oot  of  his  own  system  ;  of  which  we  have  a  clear  proof  in 
the  change  which  occurs  in  the  fourth  edition  of  his  aphorisms,  and  par- 
ticularly aphorism  755,  wharehe  lays  down  the  proximate  cause  of  inter- 
mittant  fever." — (Study  of  Medicine,  VoL  2-  p.  34J 


23 

There  are  examples  of  distinguished  teachers  abandon- 
ing their  favorite  theories,  when,  either  from  their  own  in- 
quiries, or  the  arguments  of  others,  they  have  been  proved 
to  be  erroneous.  The  late  Dr.  Armstrong  publicly  re- 
nounced his  opinion  of  the  specific  contagiousness  of  typhus 
fever.  His  biographer,  remarks  that,  "  it  has  been  object- 
ed to  him,  that  he  is  inconsistent  with  himself;  that  the 
opinions  towards  the  close  of  his  life  are  opposed  to  those 
which  he  published  at  the  outset  of  his  career.  I  admit," 
he  continues,  "the  fact,  and  claim  from  it,  an  acknowledg- 
ment from  candid  minds,  of  the  integrity  of  his  own/'  Dr. 
Rush,  though  inflexible  with  regard  to  most  of  his  medical 
opinions,  greatly  increased  the  lustre  of  his  fame  by  chang- 
ing his  views  respecting  the  causes  and  mode  of  propagation 
of  yellow  fever.  He  says  that  "  the  candor  of  Sydenham  dis- 
covers itself  by  the  readiness  with  which  he  acknowledges 
his  having  mistaken  a  nervous  fever  for  a  bastard  peripneu- 
mony ;"  and  he  adds  that  "  such  instances  of  magnanimity 
are  very  rare  in  all  sciences ;  and  from  the  influence  which 
they  have  upon  both  interest  and  reputation,  are  less  com- 
mon among  physicians,  than  men  of  other  professions.''* 

When  teachers  of  medicine  confine  their  theories  to  sub- 
jects which  have  no  direct  bearing  on  practice,  their  ambi- 
tious efforts  to  sustain  them,  are,  in  some  degree,  excusable. 
But  when  from  such  theories  are  deduced  principles  and 
rules  for  our  guidance  in  the  cure  of  diseases,  the  interests 
of  humanity  require  that  they  be  decried  and  exploded. 
Some  of  the  theoretical  systems  and  vagaries  which  have 
risen  and  flourished  in  our  own  times  are  clearly  charge- 
able, in  their  practical  application,  with  evils  of  this  kind. 
I  allude  more  especially  to  the  doctrines  of  Homoeopathy 

*  Memoir  of  the  Life  and  Medical  opinions  of  John  Armstrong,  M.D., 
&c,  by  Francis  Boott,  M.D. 


24 

and  the  fictions  of  Mesmerism.  To  those  who  have  en- 
riched their  minds  with  the  treasures  of  classical  medical 
literature,  and  made  observation  and  experience  the  basis 
of  their  reasoning  and  practice  in  medicine,  the  infinitesi- 
mal therapeutic  appliances  of  the  former,  and  the  chimeras 
and  prestiges  of  the  latter,  betray  an  utter  disregard  of 
sound  experimental  truth,  and  a  blind  or  wilful  devotion 
to  visionary  hypotheses. 

I  would  not  be  understood  as  intimating  that  the  princi- 
ples of  medicine  are  altogether  unsettled  and  constantly 
changing,  and,  therefore,  should  be  distrusted.  It  is  against 
the  seductions  of  speculation,  and  the  trammels  of  exclu- 
sive theories  only,  that  medical  teachers  should  cautiously 
guard  themselves.  There  are  great  and  fundamental  truths 
which  have  long  been  established,  and  which  constitute  the 
guides  of  rational  practice.  These  truths,  it  is  the  province 
of  the  medical  instructor  to  expound  and  illustrate.  It  is 
his  duty  rather  to  exhibit  the  structure  and  functions  of  the 
body,  the  phenomena  of  health  and  disease,  and  the  effects 
of  remedial  agents  as  ascertained  by  experience,  than  to  ex- 
pend his  labor  in  attempts  to  elucidate  final  causes,  or  to 
determine  the  manner  in  which  pathological  and  curative 
effects  are  produced.  Still  these  latter  phenomena  are  le- 
gitimate subjects  of  investigation,  and  should  be  studied 
with  all  the  cautions  inculcated  by  the  Baconian  philoso- 
phy,—always  bearing  in  mind  the  sentiment  of  a  biogra- 
pher* of  Bichafc,  that  "the  philosopher  should  confine 
himself  to  the  study  and  observation  of  the  sensible  pheno- 
mena which  the  structure  and  functions  of  organized 
matter  exhibit,  without  endeavoring  to  penetrate  further; 
—beyond,  an  immense  abyss  commences,- — we  should  take 


Bichat 


Scipio  Pinel.     See  Beclard's  Additions  to  the  General  Anatomy  of 
lat. 


25 

care,  lest  we  fall  into  it."  In  the  present  state  of  our 
knowledge,  medicine  can  receive  no  solid  accessions  from 
theoretical  systems.  It  is  justly  remarked  by  Reveille- 
Parise,  that  "  the  eclectic  school  is  the  positive  school  of 
our  art,  the  realism  of  medicine." 

But  public  medical  instruction  is  not  confined  to  collegi- 
ate institutions.  In  many  instances,  the  business  of  teach- 
ing incidentally  attaches  to  the  medical  officers  of  general 
hospitals,  and  particularly  of  metropolitan  hospitals.  These 
establishments,  though  sustained  by  the  bounty  of  the  pub- 
lic, could  have  no  existence,  or  rather  would  fail  to  fulfil 
their  benevolent  ends,  were  it  not  for  physicians  and 
surgeons.  It  is  true,  the  chief  occupation  of  medical 
men  in  hospitals,  is  to  cure  and  alleviate  disease ;  but  in 
connection  with  this  service  it  is  their  duty,  as  opportuni- 
ties may  offer  under  certain  regulations,  to  give  lessons  in 
clinical  medicine,  to  exhibit  to  the  student  the  veritable 
forms,  symptoms  and  phases  of  disease,  to  practically  illus- 
trate the  methods  of  diagnosis,  to  show  the  processes  of 
operative  surgery,  and  to  teach,  by  example,  the  art  of  pre- 
scribing the  therapeutic  and  regimenal  treatment.  In 
performing  these  duties,  medical  men  assume  a  double  re- 
sponsibility ;  first,  that  connected  with  the  welfare  of  the 
patients  committed  to  their  care ;  and  secondly,  that  rela- 
ting to  the  consequences  which  may,  in  private  practice, 
result  from  the  instruction  given  to  those,  who  follow  them 
in  their  visits  to  the  bed-side. 

In  glancing  at  the  duties  of  hospital  physicians  and 
surgeons,  we  must  not  omit  to  notice  the  obligations  resting 
on  those,  who  have  in  charge  asylums  for  the  insane.  It  is 
in  these  institutions,  that  physicians  are  called  to  exercise 
their  skill,  in  the  treatment  of  a  class  of  affections  which, 
in  many  points,  essentially  differ  from  those  admitted  into 


26 


ordinary  hospitals,  and  to  manage  which,  requires  a  kind  of 
knowledge  not  cultivated  by  the  profession  generally.  So 
important  is  this  department  of  medicine  regarded  by  the 
professional  gentlemen  at  the  head  of  the  lunatic  establish- 
ments in  this  country,  that  in  order  to  its  improvement, 
they  have  recently  formed  themselves  into  a  body,  styled 
"  The  Association  of  Medical  Superintendants  of  Ameri- 
can Institutions  for  the  Insane."  In  this  Association  they 
hope  to  be  enabled  to  accumulate  an  amount  of  experience, 
which  will  tend  to  improve  the  methods  of  treating  the 
most  formidable  of  human  maladies.  Their  purpose  is 
worthy  of  all  praise ;  and  we  cannot  doubt  that  their  la- 
bors will  result  in  the  enlargement  of  their  qualifications 
to  manage  the  thousand  varied  forms  of  moral  and  intellec- 
tual insanity, — 

"  To  minister  to  a  mind  diseased ; 
Pluck  from  the  memory  a  rooted  sorrow, 
Raze  out  the  written  troubles  of  the  brain, 
A  id  with  some  sweet  oblivious  antidote 
Cleanse  the  stuffed  bosom  of  that  perilous  stuff 
Which  weighs  upon  the  heart." 

Besides  the  various  public  duties  of  physicians,  which 
have  been  mentioned,  there  are  others  of  a  more  general 
nature.  The  character  of  a  nation  principally  depends 
upon  the  attention  it  gives  to  the  promotion  of  letters, 
science,  and  the  arts ;  and  as  the  learned  professions  em- 
brace a  large  proportion  of  those,  who  are  devoted  to  the 
advancement  of  knowledge,  it  is  obvious  that  upon  them 
chiefly  devolves  the  obligation  to  support  and  elevate  -the 
literary  and  scientific  character  of  their  country.  Of  these 
professions,  that  of  medicine  is  the  one,  from  which  are  ex- 
pected the  largest  additions  to  the  natural  sciences.  Medi- 
cal men  are  among  the  chief  laborers  in  these  departments' 


27 

of  research ;  and  hence  it  is  incumbent  on  them  to  give 
demonstrations  of  zeal  and  diligence  in  their  pursuit.  In 
which,  indeed,  of  these  branches  of  study,  have  not  medical 
men  been  always  and  every  where  actively  and  successfully 
engaged  ?  Witness,  for  example,  their  efficient  participa- 
tion in  the  recent  laborious  surveys  of  the  natural  history 
of  this  country,  conducted  under  the  authority  and  auspi- 
ces of  the  State  governments  :  and  may  I  not  specify,  in 
particular,  the  extensive  contributions  made  to  botanical 
science,  by  one  of  my  learned  friends  and  colleagues  in  this 
institution  ?* 

The  duty  to  which  I  now  refer,  though  common  to  the 
physicians  of  every  country,  is  perhaps  especially  impera- 
tive on  those  of  America,  on  account  of  the  assertion  long 
since  made  that  the  climate  and  soil,  and  also  the  animal 
and  vegetable  productions  of  this  continent  are  inferior  to 
those  of  Europe.  This  assertion,  being  unsupported  by 
facts,  would  never  have  required  an  elaborate  refutation, 
had  it  proceeded  from  persons  of  less  distinction  than  Buf- 
fon,  Robertson,  and  the  Abbe  Raynell.  The  mere  authority 
of  such  names  has  had  the  effect  to  impress  on  the  minds 
•of  Europeans  a  belief  of  its  truth.  The  simple  denial 
of  it  on  our  part,  has  not  been  sufficient  to  rebut  the  asper- 
sion. Positive  proofs  have  been,  and  perhaps  are  still  re- 
quired to  show  its  falsity.  Among  those  who  have  suc- 
cessfully defended  our  country,  against  the  charge  of  infe- 
riority, none  have  offered  stronger  facts,  or  more  convincing- 
arguments  than  physicians.  The  late  Dr.  Williamson  has 
clearly  and  satisfactorily  shown  that  "there  is  not  any  vice 
cf  the  climate,  or  combination  of  elements  which  prevents 
ihe  expansion  of  animated  nature,  and   causes   man  and 

*  John  Torrey,  M.D.  LL.D. 


28 


beast  to  degenerate."  It  is  undeniable  that  a  country 
overspread  with  forests,  the  growth  of  a  thousand  years, 
and  untouched  by  the  plough  and  the  spade,  is  not  in  a 
condition  to  favor  the  development  of  the  higher  intellec- 
tual  and  moral  powers.  But  this  fact  is  no  proof  that  its 
climate  is  radically  vicious.  The  atmosphere  of  America 
is  essentially  the  same  in  its  constitution  as  that  of  Europe. 
The  sun  shines  as  resplendently  in  our  western  skies,  as  he 
does  in  those  of  France,  Italy,  and  Greece ;  and  when  the 
American  soil  shall  be  further  subdued  by  agricultural  in- 
dustry, may  we  not  expect  an  amelioration  of  climate? 
Already  in  this  respect,  has  a  remarkable  change  been  ef- 
fected ;  and  there  is  reason  to  believe,  that,  at  a  period  not 
very  distant,  the  United  States,  in  some  parts  at  least,  will 
possess  an  atmosphere  as  pure  and  invigorating,  as  exists  in 
the  most  favored  regions  of  the  earth.  It  cannot  be  con- 
ceded that  the  climate  of  our  country  has  at  any  time  pre- 
vented the  expansion  of  the  human  mind.  In  its  primitive 
state,  it  may  have  had  such  a  tendency ;  but  that  tendency 
has  been  rendered  inoperative  by  circumstances  of  a  moral 
and  political  nature,  circumstances  sufficiently  powerful  to 
overcome  greater  evils  than  the  depressing  climatic  in- 
fluences of  an  uncultivated  country. 

Temperate  climates  are  peculiarly  favorable  to  the  de- 
velopment of  the  physical  and  intellectual  constitution  of 
man.  That  portion  of  the  eastern  continent,  which  lies 
between  the  twenty-third  and  sixtieth  degrees  of  north 
latitude,  embraces  all  the  countries,  in  which  our  species 
have  attained  the  highest  degree  of  perfection.  With  this 
fact  before  us,  what  may  we  not  hope  for  in  the  correspond- 
ing latitudes  of  North  America?  The  United  States  on 
the  western  continent,  and  Portugal,  Spain,  Italy,  Greece, 
together  with  a  part  of  France,   Germany,   Egypt,  and 


29 

Arabia  lie  within  the  same  parallels :  and  consequently  under 
similar  circumstances,  we  should  expect  man  to  become  as 
highly  improved  and  polished  in  the  one  as  in  the  other.  A 
comparison  of  places  equally  distant  from  the  equator  on 
the  two  continents  would  not  in  the  present  age,  be  humilia- 
ting to  our  country.  Rome  once  the  seat  of  universal  em- 
pire, is  nearly  in  the  same  latitude  with  Boston  ;  but  though 
possessing  a  milder  physical  elimate,  and  superior  in  adven- 
titious splendor,  has  produced  few  statesmen  or  philosophers 
equal  to  Franklin.  If  we  trace  the  lines  of  latitude,  which 
intersect  Greece,  through  our  own  country,  we  shall  find 
them  to  pass  through  Virginia,  the  birth-place  of  Washing- 
ington,  in  whom  were  united  the  moral  daring  and  personal 
courage  of  Philip  and  Alexander,  the  patriotism  of  Epam- 
inondas,  the  legislative  wisdom  of  Solon,  and  the  sublime 
moral  sense  of  Plato.  Such  comparative  remarks  might 
be  extended  to  almost  every  elimate  of  our  republic,  and 
in  no  instance  should  we  have  reason  to  blush.  "  If  genius, 
industry,  erudition,  and  the  liberal  arts  are  begotten  and 
nourished  in  a  temperate  climate  and  a  pure  atmosphere," 
says  Dr.  Williamson,  "  America  has  much  to  expect,  for 
the  climate  will  ever  be  temperate,  and  the  atmosphere 
pure,  through  the  greater  part  of  the  continent." 

The  Americans,  I  am  aware,  have  been  accused  of  too 
much  self-flattery ;  and  a  British  medical  journalist  has 
hinted  the  impolicy  of  praising  ourselves  so  immeasurably, 
as  we  thereby  leave  no  room  for  others  to  perform  that 
friendly  office  for  us,  on  proper  occasions.  The  accusation 
perhaps  is  just ;  but  when  we  reflect  that  it  is  only  within 
a  few  years  that  our  moral  and  political  institutions,  our 
arts,  literature,  and  sciences  have  been  deemed  worthy  of 
serious  examination,  and  much  less  of  comparison  with 
those  of  Europe,  we  shall  find  just  ground  of  apology  for 


30 

the  alleged  impropriety.  It  is  by  no  means  wonderful  that 
in  defending  ourselves  against  the  imputation  of  degeneracy, 
we  may  have  been  urged  by  the  taunts  of  Europeans  to 
rate  our  attainments  in  knowledge  and  moral  excellence, 
more  highly  than  sober  reflection  would  justify.  Happily 
the  period  has  arrived  in  which  more  friendly  feelings  are 
reciprocally  manifested,  and  in  which  the  scientific,  medi- 
cal, theological,  and  literary  productions  of  our  country- 
men mingle  with  those  of  Europe,  and  every  where  receive, 
according  to  their  merit  the  respect  due  them  in  the  great 
community  of  philosophy  and  letters. 

-Gentlemen,  Graduates,  and  Students  of  Medicine : 

In  thus  bringing  before  you  some  of  the  public  duties 
of  physicians,  it  has  been  my  purpose  to  show  that  the 
science  of  medicine,  so  far  from  being  limited  in  its  appli- 
tion  to  private  or  clinical  practice,  has  bearings  on  objects 
intimately  connected  with  the  prosperity,  happiness,  and 
character  of  your  country.  A5'  science  with  relations  so 
various  and  important,  affords,  it  is  believed,  ample  room 
for  the  exercise  of  the  highest  order  of  intellect.  Emi- 
nence, founded  on  positive  merit,  is,  in  few  vocations, 
more  universal  and  durable  than  in  the  profession  of 
medicine.  The  desire  to  rise  to  an  equality  with,  or 
superior  to  others  is  a  feeling  common  to  noble  minds,  and 
which,  if  duly  cherished,  doubles  the  power  of  the  under- 
standing, and  sustains  it  in  its  highest  efforts.  Let  ambi- 
tion, therefore,  regulated  by  principles  of  virtue  and  honor, 
exert  within  you  its  stirring  influence,  ever  remembering, 
that  united  with  talent  and  industry,  it  is  the  means  of 
mighty  achievement, — it  is  the  source  of  immortal  re- 
nown. 


COLUMBIA  \ 

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expiration  of  a  deficit 

«  Provided  by  £?2 

lenient  with  tLe  U 


; Y  ^IBKAKY 


[fate  of  borrows 
— ~*  **ry  or  W  r,       •        *' 
•^n  in  charge.        y  SpeciaJ  ar- 


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